Chapter 10: Challenges of Nursing Management and Leadership Zerwekh 9th ED

18. What types of changes in management can be anticipated with the introduction of generations X and Y to the nursing work force? a. More flexible work time and increased personal responsibility for work outcomes b. Increased loyalty to the institution and the need for a well-defined work environment c. Increased interest in the goals and needs of the institution d. Increased structure within the nursing environment to more effectively predict outcomes

ANS: A Members of generations X and Y are more independent and place higher value on personal time. They are not characteristically team players, but they are very creative and want to be responsible for their work outcomes. Baby Boomers are focused on building careers and are invested in organizational loyalty. The silent or veteran generation places high value on loyalty, discipline, teamwork, and respect for authority. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 218 OBJ: Identify distinguishing generational characteristics of today's workforce. TOP: Generations X and Y MSC: NCLEX®: Not applicable

6. The nurse manager is beginning the process of problem solving. Which action should be taken first? a. Define the problem. c. Analyze the information. b. Gather information. d. Consider the alternatives.

ANS: A The good manager will guide the process of defining or identifying the problem by asking the what, when, and where of the problem. Before the manager can perform any of the other steps of problem solving, the problem must be identified. Importance is placed on management's ability to differentiate between facts and opinions and to attempt to break down the information to its simplest terms. PTS: 1 DIF: Cognitive Level: Application REF: p. 224 OBJ: Apply problem-solving strategies to clinical management situations. TOP: Nursing management MSC: NCLEX®: Not applicable

4. The nursing staff on a busy unit enjoys autonomy and needs minimal direction for patient care. Which leadership style would be most effective on this unit? a. Democratic c. Laissez-faire b. Authoritarian d. Bureaucratic

ANS: A The democratic manager is people oriented and emphasizes effective group functioning. The environment is open, communication is both ways, and staff members are encouraged to participate in decision making. The manager is also willing to take responsibility to make decisions when staff participation is not necessary. An authoritarian leader makes decisions without the input of others. The laissez-faire manager maintains a permissive environment. The bureaucratic leader follows a close set of standards to maintain order. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 212 OBJ: Describe various types of management. TOP: Nursing management MSC: NCLEX®: Safe and effective care environment—management of care

24. The nurse manager identifies which of the following as the most critical step in problem solving? a. Brainstorm all possible solutions. c. Evaluate possible solutions. b. Identify the problem. d. Choose a solution.

ANS: B The most critical step in the problem solving process is to identify the problem. Brainstorming solutions, evaluating possible solutions, and choosing a solution occur after the problem has been identified. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 224 OBJ: Apply problem-solving strategies to clinical management situations. TOP: Management problem solving MSC: NCLEX®: Not applicable

7. A nurse is using the decision-making process. Which action should be taken first? a. Evaluate the outcome. c. Set the objective. b. Identify and evaluate options. d. Implement the options.

ANS: C Decision making requires the definition of a clear objective to guide the process. The nurse must set the objective before proceeding to the other steps in the decision-making process. The second step is to identify and evaluate alternate decisions. The third step is to make the decision and implement, and the last step is to evaluate the outcome. PTS: 1 DIF: Cognitive Level: Application REF: p. 226 OBJ: Use the decision-making process in clinical situations. TOP: Nursing management MSC: NCLEX®: Not applicable

2. What action would be an appropriate first step for the nurse to take toward becoming an effective manager? a. Learn how to effect and direct the change process. b. Assess individuals' sources of power. c. Develop communication and interpersonal skills. d. Implement effective nursing care plans.

ANS: C Effective managers have a balanced mix of management skills and leadership qualities. There are generally four functions the manager performs: planning (what is to be done), organizing (how it is to be done), directing (who is to do it), and controlling (when and how it is done). To be effective in performing these functions, a manager must develop communication and interpersonal skills. PTS: 1 DIF: Cognitive Level: Application REF: p. 212 OBJ: List characteristics of an effective manager and an influential leader. TOP: Nursing management MSC: NCLEX®: Safe and effective care environment—management of care

20. A nurse manager has an adequate understanding of their nursing role when making which of the following statements? a. "A manager selects or assumes a role." b. "I have the same function as a floor nurse." c. "I have the same authority as the director of the hospital." d. "I was appointed to my role."

ANS: D Whereas a manager is assigned or appointed to a role, a leader selects or assume a role. The nurse manager functions differently than a floor nurses, and although the nurse manager has some authority, it is less than the director of the hospital. PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ: Differentiate between management and leadership. TOP: Management versus leadership MSC: NCLEX®: Not applicable

11. The nurse manager on a surgical unit receives notification that multiple victims of a plane crash will arrive at the hospital momentarily. What is the most appropriate leadership style to adopt in this situation? a. Authoritarian c. Laissez-faire b. Democratic d. Eclectic

ANS: A The authoritarian style of management has its emphasis on the tasks, which would be effective during an emergency or disaster situation; hence, the autocratic manager may be most effective in a crisis situation. The laissez-faire manager maintains a permissive climate with little direction or control exerted. This manager allows staff members to make and implement decisions independently and relinquishes most of his or her power and responsibility to them. The democratic manager is people oriented and emphasizes effective group functioning. The environment is open, communication is both ways, and staff members are encouraged to participate in decision making. Eclectic is not a specific leadership management style. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 211 OBJ: Differentiate between power and authority. TOP: Nursing management MSC: NCLEX®: Not applicable

5. Which statement best describes effective leadership by the nurse manager? a. Directs a staff nurse to modify his or her communication skills b. Fosters behavior changes in one staff member that have positive effects on the nurse manager and his or her peers c. Encourages behavior changes through the annual evaluation process d. Uses the group process to determine what behavior is distressing to staff

ANS: B Leadership in groups is democratic; the members feel positive about their participation and the outcomes of the group process. The other options are not examples of effective leadership. This person should be flexible enough to adapt to the changing roles of nursing staff. The nurse manager/leader should be willing and able to share power with the same people that he or she will supervise. It is important to understand that the most effective leadership style for one situation is not necessarily the most effective for another. Research indicates that the effectiveness of the leader is influenced by the situation itself. As leadership theories continue to develop, emphasis is more on what the leader does rather than on the traits the leader possesses. Effective leadership revolves around the leader focusing a group's efforts on identifying goals and carrying out the activities needed to reach those goals, not necessarily on individual issues, such as an annual evaluation processes or working with a staff to change communication skills. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 216 OBJ: List characteristics of an effective manager and an influential leader. TOP: Nursing management MSC: NCLEX®: Not applicable

19. The nurse understands that having a stand-up meeting versus the traditional (sitting at a conference table) meeting takes less time to come to a decision based on which of the following ideas? a. Contingency-style leadership b. Evidence-based management protocols and interventions c. Autocratic management style d. Presence of a clinical nurse leader (CNL)

ANS: B Nurses are expected to practice using evidence-based protocols and interventions for clinical decision making, and managers are expected to use those management practices that are not simply based on conventional wisdom but on demonstrated outcomes. Evidence indicates that stand-up meetings took 34% less time to make decisions (Pfeffer & Sutton, 2006). Using this model could save an organization many hours a year that can be put to another productive use or could be eliminated from the payroll. However, very few organizations use this model for meetings even in the face of the clear evidence of the impact it would have on the organization. The CNL is a highly prepared individual in the clinical setting whose role is to positively impact patient safety issues by identifying and managing risk while meeting standards of quality clinical care. Autocratic management style is authoritative. Contingency leadership style is a style of leading that is flexible to adapt to the situation. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 225 OBJ: Discuss the value of using evidence-based management actions. TOP: Nursing management MSC: NCLEX®: Not applicable

13. Which statement by the staff nurse shows adequate understanding of the nurse manager role? The nurse manager: a. "is given information and power through an official position." b. "coordinates group activities toward a common goal." c. "is responsible for developing goals to be accomplished." d. "selects and assumes a role among a group of peers."

ANS: B The manager coordinates the activities of the group to maintain balance and direction. There are generally four functions the manager performs: planning (what is to be done), organizing (how it is to be done), directing (who is to do it), and controlling (when and how it is done). Good leaders carefully balance job-centered and employee-centered behaviors to meet both staff and patient needs effectively and often have information and power through an official position. A good leader works toward developing goals and has a sense of purpose and direction. A good leader must also be aware of how her or his behavior impacts the workplace. Emotions, moods, and patterns of behavior displayed by the leader will create a lasting impression on the behavior of the team involved. A team member is a person who assumes a role among a group of peers. PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ: List characteristics of an effective manager and an influential leader. TOP: Nursing management MSC: NCLEX®: Not applicable

1. What is the most consistent concern of the nurse as manager? a. To develop long-range career goals b. To coordinate patient care while meeting the agency goals c. To maintain harmony within the agency d. To organize the subordinates to meet agency goals

ANS: B The role of the nurse as manager has evolved into a complex one that includes organizing patient care, directing personnel to achieve agency goals, and allocating resources. The most consistent concern of the nurse as manager is not to develop long-range career goals, maintain harmony within the agency, or organize subordinates to meet agency goals. Although having long-range career goals is a good idea for the nurse manager, it is not a day-to-day concern. Organizing subordinates in not a role of the nurse manager, but instead it is directing or supervising them to achieve patient care needs. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 208 OBJ: List characteristics of an effective manager and an influential leader. TOP: Nursing definition MSC: NCLEX®: Safe and effective care environment—management of care

9. A nurse is interested in moving into a management position. Which action would assist with accomplishing this? a. Use of reward power c. Use of expert power b. Use of coercive power d. Use of legitimate power

ANS: C An expert refers to someone who is knowledgeable, experienced, and respected in his or her area of nursing. This type of expert power would assist the nurse to advance to higher positions in nursing. Reward power is closely linked with legitimate power in that it comes about because the individual has the power to provide or withhold rewards. Legitimate power is power connected to a position of authority. Coercive power is power derived from fear of consequences. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222 OBJ: Differentiate between power and authority. TOP: Nursing management MSC: NCLEX®: Not applicable

15. A nurse is unhappy about the way medications are being administered on the unit. What does the nurse need to do first to facilitate a change in the process? a. Initiate a new method starting with assigned patients. b. Discuss concerns with fellow nurses. c. Develop a better method to administer the medications. d. Inform the charge nurse of how it can be done better.

ANS: C The nurse needs to shift into the moving phase, which incorporates taking the lead by being responsible and willing to implement change by sorting out what must be done and by facilitating an appropriate and effective approach. Whenever one is not happy with a situation or procedure, it is important that providing suggestions for change be incorporated into the process. Discussing concerns with fellow nurses does not actively involve the change process. For change to be effective, it must have "buy-in" from other staff and not merely inform the staff or change nurse of how there is a better way to administer the medications on the unit. PTS: 1 DIF: Cognitive Level: Application REF: p. 229 OBJ: Discuss the change process. TOP: Nursing management MSC: NCLEX®: Not applicable

22. A nurse manager has received a report that indicates the infection rate on the unit has gone up by 25% in the past month. The control phase of management requires that the nurse manager take action. What should the nurse manager do? a. Post the report for staff to read. b. Pull a couple of the nurses aside and discuss the issue with them. c. Send an email out to the staff with information regarding upcoming infection prevention conference. d. Provide a mandatory handwashing in-service to all staff.

ANS: D The nurse manager has a duty to implement and mandate interventions to reduce infection rates for her unit. Providing a mandatory handwashing in-service to all staff is the best way to do this and to ensure that every staff member is competent. The other options may be used in the process for the nurse manager to set up or reinforce the handwashing in-service program. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 208 OBJ: Differentiate between management and leadership. TOP: Management versus leadership MSC: NCLEX®: Safe and effective care environment

8. Which statement by the nurse shows understanding of the primary advantage in using the group process in decision making? The process a. "increases the time spent discussing alternatives." b. "eliminates opposition to decisions by administrators." c. "allows additional time for the planning process." d. "promotes acceptance of the decision by the group."

ANS: D When the group has input in the decision-making process, there is more acceptance of the group's decision. Groups can be beneficial to the decision-making process. Groups generally offer the benefits of a broader knowledge base for defining objectives and more creativity in identifying alternatives. The effectiveness of the group decision-making process is dependent on the dynamics of the group. When a group is involved in the decision-making process, there may be additional time spent discussing alternatives, and more time may be allowed for planning; however, this is not a specific advantage. It may not necessarily eliminate opposition to the decision by administration, but when the group makes a decision, it may be easier to deal with administrative opposition. PTS: 1 DIF: Cognitive Level: Application REF: p. 212 OBJ: Identify characteristics of effective work groups. TOP: Nursing management MSC: NCLEX®: Not applicable

4. Which of the following describes reward power used by the nurse manager? (Select all that apply.) a. A nurse manager who uses fear of consequences to motivate staff b. A nurse manager who uses salary increases to motivate staff c. A nurse manager who is perceived as an expert due to specialized knowledge d. A nurse manager who is well liked by the majority of staff e. A nurse manager who has information that others need to perform their jobs

ANS: A, B Reward power occurs when nurse managers provide or withhold rewards. A nurse manager who is perceived as an expert has expert power. A nurse manager who is well liked the majority of staff has referent power. A nurse manager who has information needed by others to perform their jobs has informative power. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222 OBJ: Differentiate the concepts of power and authority. TOP: Power and authority in nursing management MSC: NCLEX®: Not applicable

1. Which of the following actions is consistent with a manager? (Select all that apply.) a. Planning the agenda for a staff meeting b. Directing nurse assistants in how to divide up patient care assignments c. Organizing a group of nurses to present a topic at a staff meeting d. Giving blood at the local hospital blood drive e. Assume control of the guidelines for how hourly rounding will work on the unit

ANS: A, B, C, E Managers plan, direct, organize. and control activities designated to their staff. Giving blood at the local hospital would not be an action that is consistent with a nurse manager role. PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ: Differentiate between management and leadership. TOP: Management versus leadership MSC: NCLEX®: Not applicable

3. Which of the following statement by the nurse reflect transformational leaders? (Select all that apply.) a. Lifelong learners b. Courageous change agents c. Slow to change d. Value-driven visionaries e. Hesitant to follow

ANS: A, B, D Transformational leaders are lifelong learners, courageous change agents, and value driven visionaries. They are not slow to change or hesitant to follow. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 214 OBJ: Describe theories of management and leadership. TOP: Management versus leadership MSC: NCLEX®: Not applicable

2. A nurse manager is in the planning phase in a new job. Which action shows this? (Select all that apply.) a. Developing goals that reflect the mission and vision of the organization b. Defining strategies to meet the mission and vision of the organization c. Providing direction for staff to perform the work of the organization d. Retaining accountability for all work completed by the staff e. Planning for contingencies which may interfere with the work of the organization

ANS: A, B, E In the planning phase, the nurse manager will develop goals, define strategies, and plan for contingencies that may interfere with the work. The next phase of management is providing direction to staff and retaining accountability for all work completed by the staff. PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ: Management versus leadership. TOP: Differentiate between management and leadership MSC: NCLEX®: Not applicable

10. A nurse is respected by peers for clinical skills and effective interpersonal relationships. The nurse has studied diabetic patient educational needs and consults with several units. What type of power does this nurse possess? a. Informational c. Reward b. Legitimate d. Expert

ANS: D Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Those who have information that others need to perform their duties have informational power. Legitimate power is based on the person's position within an organization. Reward power occurs when an individual has the power to give or withhold rewards. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222 OBJ: Differentiate between power and authority. TOP: Nursing management MSC: NCLEX®: Not applicable

21. Which of the following actions is consistent with a nurse leader? a. A nurse who encourages staff to give excellent patient care b. A nurse who performs chart audits on her staff c. A nurse who writes yearly staff evaluations d. A nurse who gives pain medication to an assigned patient

ANS: A A nurse leader is someone who influences others, such as a nurse who encourages staff to give excellent patient care. A nurse who performs chart audits and writes staff evaluations is functioning as a nurse manager. Giving pain medications is a function of the staff or bedside nurse. PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ: Differentiate between management and leadership. TOP: Management versus leadership MSC: NCLEX®: Not applicable

14. The nurse manager is giving a presentation on the disadvantages of democratic leadership in group functioning. Which statement shows an understanding of this type of leadership? a. "Requires more time and effort to make decisions and accomplish goals" b. "Discourages participation from quieter members of the group" c. "Increases the possibility of "scapegoating" or argumentative behavior" d. "Is difficult to control the outcomes and decisions of the group"

ANS: A Because of the encouragement of participation in decision making and the democratic leadership's emphasis on group function, decision making becomes more involved with consensus and is less timely. Democratic leadership encourages group participation and works to reduce any type of scapegoating behavior among members because everyone has equal voice. The group democratically makes decisions and determines outcomes that are not controlled by management. PTS: 1 DIF: Cognitive Level: Application REF: p. 212 OBJ: Discuss theories of management and leadership. TOP: Nursing management MSC: NCLEX®: Not applicable

16. A nurse wants to implement a change in the work environment. Which of the following actions would be the most important thing to do? a. Ask for suggestions from peers working in other institutions. b. Explain to coworkers how a different plan would work better. c. Seek input from coworkers from the beginning. d. Incorporate all suggestions into the plan before implementing.

ANS: C Seeing the input from coworkers from the beginning is an important component of initiating change in the work environment. In the unfreezing phase, all of the factors that may cause resistance to change are considered. Others who may be affected by the change are sought out to determine whether they recognize that a change is needed and to determine their interest in participating in the process. It will be important to determine whether the environment of the institution is receptive to change and then convince others to work with the group initiating the change. PTS: 1 DIF: Cognitive Level: Application REF: p. 229 OBJ: Discuss the change process. TOP: Nursing management MSC: NCLEX®: Not applicable

3. What do the responsibilities of the nurse manager include? a. Planning and organizing how nursing care can most effectively be delivered on the nursing unit b. Establishing the nursing care standards to be implemented on the unit c. Developing educational programs to assist staff to meet licensure requirements d. Assisting staff to adhere to organizational policies and procedures

ANS: A Managers must be attentive to both dimensions of their job: the mission and goals of the organization and planning with the staff to meet the nursing care goals of the unit within the overall goals of the institution. Both levels must be addressed—the organization as well as the needs of the individuals. Other options are not as comprehensive and could be included within the first option. PTS: 1 DIF: Cognitive Level: Application REF: pp. 208-210 OBJ: List characteristics of an effective manager and an influential leader. TOP: Nursing management MSC: NCLEX®: Safe and effective care environment—management of care

17. If many complaints arise about a newly developed procedure, what is the best way to handle them? a. Discontinue the change because it is not working. b. Persuade a few friends to talk positively about it. c. Consider the complaints as indications that change is being resisted. d. Analyze the complaints and alter the plan as needed.

ANS: D In handling complaints about a new procedure, consideration should be given to bringing in a person with expert power and returning to the moving phase for analysis and adjustment of the procedure if needed. Because a complaint occurs does not mean that the change is being resisted. Until the complaint is investigated, the change should continue; it should not be discontinued until the issue is fully determined and resolved about the newly developed procedure PTS: 1 DIF: Cognitive Level: Application REF: pp. 226-227 OBJ: Discuss the change process. TOP: Nursing management MSC: NCLEX®: Not applicable

25. Which action by the nurse indicates placement in the unfreezing phase of Lewin's Change Theory? a. The nurse reconsiders what has caused themself to be resistant to change. b. The nurse begins the process of implementing change. c. The change has become routine. d. The change is permanent.

ANS: A Lewin's Change Theory consists of three phases: unfreezing, moving, and refreezing. In the unfreezing phase, the nurse reconsiders what has caused her to be resistant to change. In the moving phase, the nurse begins the process of implementing change. In the refreezing phase, the change has become a permanent, routine part of the nurse's life. PTS: 1 DIF: Cognitive Level: Application REF: p. 230 OBJ: Discuss the change process. TOP: The challenge of change MSC: NCLEX®: Not applicable

23. Which of the following actions by the nurse manager would indicate an autocratic management style? a. Allows staff members to make most of the decisions b. Makes most of the decisions without input from the staff members c. Exerts little control over staff d. Emphasizes effective group functioning

ANS: B The autocratic manager uses an authoritarian approach to direct the activities of others. This manager would make most of the decisions without input from the staff members. Allowing staff members to make most of the decisions and exerting little control over staff is a laissez-faire management style. Emphasizing effective group functioning is common for a democratic management style. PTS: 1 DIF: Cognitive Level: Application REF: p. 211 OBJ: Differentiate the concepts of power and authority. TOP: Management versus leadership MSC: NCLEX®: Not applicable

12. The nurse manager tells the patient that he must eat his breakfast before getting out of bed. What type of power is the nurse manager using? a. Legitimate power c. Coercive power b. Expert power d. Referent power

ANS: C Coercive power is power derived from fear of consequences. Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Reward power is closely linked with legitimate power in that it comes about because the individual has the power to provide or withhold rewards. Legitimate power is power connected to a position of authority. Referent power is power that a person has because others closely identify with that person's personal characteristics; the person is liked and admired by others. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222 OBJ: Differentiate between power and authority. TOP: Nursing management MSC: NCLEX®: Not applicable